Episode 13: Deny, Deny Deny

This has been a hard week. I worked all weekend, and I’m starting back on the wards next Monday, so there’s no time to rest this week. Add to this that my fitness camp-high has waned, and for the last two days, I’ve been feeling really discouraged about life, the universe, and everything. Not to mention the fact that at this rate I will never get through all the Grey’s episodes in time to meet the 1-year deadline. One post a week is not good enough, I know.

But my whining is not at all interesting, so let’s just jump right in to the episode. The opening, in our favorite bar across from the hospital, features one of the best exchanges on the show to date, as Izzie and George talk about Cristina's response to her recent ordeal:

Izzie: “She’s acting like she has no emotions or warmth, like she’s missing a soul.”

George: “God, she’s going to make a great surgeon.”

Cristina Yang is in the hospital, recovering from her surgery for her ectopic pregnancy. In the first scene we see her underwear as she drags an IV pole down the hall, and from rounds, Douche with a Heart of Gold (DHG) yells, "Nice panties, Yang!"

Oh, Cristina, I feel your pain, because the one time I was hospitalized overnight, they immediately stole all my clothes and put me in an XXXL johnny with a wide, unflattering ruffle at bosom-level. It hung off me (I'm not, like, skinny, but I'm not an XXXL and plus I was extremely dehydrated) and periodically the giant ruffle on the front pulled the whole thing forward, giving any bystanders a quick flash of my chest.  How quickly we strip our patients of their dignity.

                              How quickly we strip patients of their dignity.

Because she's bored or humiliated or maybe because her mother is in the room and is driving her absolutely crazy, she spends the episode sneaking around looking at charts of her co-interns’ patients. 

George: What are you doing?

Cristina: I’m trying to figure out what’s going on with the crazy woman on 4.

George: You are the crazy woman on 4.

The patient Cristina finally hones in on is a woman that we know has Munchausen’s from the first second she’s on-screen, when she’s surrounded by group of admiring health care workers. This is consistent with a typical Munchausen’s profile (making friends with the staff), but is certainly not subtle. Of course, this show isn’t about diagnostic dilemmas, so I’ll forgive them. I first learned about Munchausen’s from my medical school professor, Tom Duffy, who described a case of a patient he called "The Red Baron" because the patient had a habit of showing up at many different hospitals with a complaint of a syndrome that damages the lungs and kidneys, and he added blood to his urine to keep his doctors believing in his illness. I learned about Munchausen's by proxy when I was taking care of a pediatric patient who kept mysteriously getting sick whenever his mother showed up to visit. Or maybe that was just a Law and Order episode. It's so easy to mix up Law and Order with real life.

A few scenes later, we see the Munchausen’s patient take a mysterious pill and then drop to the floor in a sudden ventricular arrhythmia. This arrhythmia responds to a CPR technique that only works on TV: The precordial thump. Again, echos of Lost, season 1, where the precordial thump saved at least three lives. Don’t ask me the mechanism, because I’m not sure.

The nail in the coffin that this patient has Munchausen’s is when she asks Dr. Burke for specific medical interventions:

“An echo? What about  cardioversion or ablation? Won’t I need a pacemaker or a permanent internal defibrillator?”

(Later, Izzie refered to it as “The echo test.” It’s never called an “echo test.” Just an “echo.” ) This plot begins to really unravel when they see the patient has blue urine. Based on this evidence, the doctors blame self-administered amitryptiline for the whole thing, and this is just a little farfetched. Amitryptiline can turn the urine blue occasionally, but it’s unlikely that both her urine would be blue and she could have taken enough to cause an arrhythmia without being so sedated that she required intubation.

In the end, Cristina is right about the Munchausen’s diagnosis and, for some reason, this realization sends her into a spiral of disaster. She sobs and cries and and finally begs, “Somebody sedate me!"

Again, Cristina, I know how you feel. 

Later, Burke shows up in a white blazer and snuggles with her in bed, right there in front of her mother. It’s mortifying, but again, I refuse to care about this relationship. I’m going to ignore it until it goes away. Deny, Deny, Deny, is right.

In McDreamy news, i t seems like the McDreamies really are on the rocks this time, seeing as Addison showed up with divorce papers in this snappy scene:

McDreamy: You really are Satan. If Satan were to take physical form, he’d be you. Everywhere. All the time.

Addison: I am so not Satan.

McDreamy: How come haven’t you gotten back on your broomstick and gone back to New York where you belong?

Addison: You are going to forgive me eventually, right? There was a time when you thought of me as your best friend.

McDreamy: There was a time when I thought of you as the love of my life. Things change.

Addison: Have you ever thought that even if I am Satan, even if I am an adulterous bitch, that I still might be the love of your life?

                                              

In the meantime, McDreamy is caring for a man whose wife shot him because he’s cheating on her. He tells McDreamy at the end of the episode.

“You know what I am? I’m stupid. Nothing will make you feel more stupid than cheating on the woman you love.”

This comment makes McDreamy all reflective. Uh-oh. He may not sign those papers. 

Bailey is taking care of a triathlete/CF patient with pancreatitis, someone she describes as “very near and dear to her heart.” Again, he looks way too good to have the illness he’s supposed to have (and way too good to be a DNR, which he supposedly is), but then he codes in the OR and, once again, a Grey’s physician codes a patient with DNR status. After they (finally) call the code, it's very sad to watch Dr. Bailey make the call to tell his parents that he's dead. It reminded me of one of the most difficult moments of my career - losing a 20-something CF patient who was almost as adorable as this actor. I watched him say goodbye to his mother, and I’ve never forgotten that sad, horrible, scary moment.

Best Bailey Line of the episode (to McDreamy):

“You have put yourself between two very fine women, and you’re looking for an easy way out. It’s not gonna happen.”